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Policy Updates October 2017
Medical Coverage Policy
- Benign Prostatic Hyperplasia Treatments – (0159)
- Colorectal Cancer Screening and Surveillance – (0148)
- Kidney Transplantation, Pancreas-Kidney Transplantation, and Pancreas Transplantation Alone – (0146)
Pharmacy (Drugs & Biologics) Policies
- Abatacept – (6112)
- Anakinra – (4063)
- Anti-Tumor Necrosis Factor Therapy – (9014)
- Interleukin-12/23 and 17 Antagonists – (1017)
- Tocilizumab – (1024)
- Tofacitinib – (1410)
- Vedolizumab – (1502)
- Apremilast – (1414)
- Hepatitis C Therapy – (1316)
- Deflazacort – (1708)
- Drugs / Biologics Not Covered Unless Approved Under Medical Necessity Review – Employer Group Plans: Value Prescription Drug List and Advantage Prescription Drug List – (1602)
- Immune Globulin – (5026)
- Interleukin (IL)-5 Antagonists: Mepolizumab and Reslizumab – (1608)
- Nusinersen – (1707)
- Oncology Medications – (1403)
- Step Therapy – (1109)
Policies with a Reduction in Coverage
Policy Alerts monitors Commercial and Medicare medical policies for changes. While Payers typically update medical policies annually, there are many reasons why a Payer might review or update a policy. When reviews occur out of cycle, they may go unnoticed. Policy Alerts keeps you informed of upcoming and unexpected coverage changes affecting your product. Quickly understanding the changes Payers make can help you adjust reimbursement strategies impacting your business.
Policy Alerts continuously monitors Commercial and Medicare Payer coverage information to keep you up-to-date on Payer decisions in real-time. Whenever changes occur, email notifications containing a summary of those changes are delivered to your inbox. Clients can access detailed coverage reports and medical policies on the interactive Dashboard portal. Save time and keep focused on the important Payer medical policy reviews and coverage decisions affecting your product!
Policy Alerts takes a client-focused hands-on approach and works hard to provide our customers with helpful insights and actionable analytics over raw data. We understand what our clients need and we are dedicated to making sure we provide timely, accurate and always up-to-date reports that can be used to implement and support a successful reimbursement strategy.
Health economic and reimbursement information provided by Policy Alerts is gathered from third-party sources and is subject to change without notice as a result of complex and frequently changing laws, regulations, rules and policies. This information is presented for illustrative purposes only and does not constitute reimbursement or legal advice.